Panel Urges Control of Cancer-Related Pain, Depression, Fatigue

Sunday, September 1, 2002

Volume:

11

Issue:

9

BETHESDA,
MarylandLabeling the treatment of pain, depression, and fatigue in many
cancer patients inadequate, a National Institutes of Health (NIH)
state-of-the-science panel has called for optimal symptom control for all
cancer patients from diagnosis and throughout their illness. It also called for
escalated funding to support research on the definition, occurrence,
assessment, and treatment of all three problems.

"Currently, cancer-related pain, depression, and
fatigue are undertreated, and this situation is simply unacceptable," said
chair Donald L. Patrick, PhD, MSPH, professor and director of the Social and
Behavioral Sciences Program, Department of Health Services, University of
Washington, Seattle. "There are effective strategies to manage these
symptoms, and all patients should have optimal symptom control."

The 13-member panel spent 2 days listening to expert
testimony and drafting a statement. It released its final report on the third
day of the conference after hearing public comments on the draft. Although
sponsored by the National Cancer Institute and NIH’s Office of Medical
Applications of Research, and co-sponsored by six other NIH units and the FDA,
the panel was an independent body, and its statement does not represent NIH or
federal policy.

In its report, the panel addressed five issuesoccurrence,
the reliability and
validity of methods for clinical assessment, the effectiveness of treatments,
impediments to effective symptom management, and future directions for
research.

With regard to the occurrence of pain, depression, and
fatigue, "published studies on all three symptoms are virtually restricted
to prevalence data; there are no reliable incidence studies," the report
said. Prevalence studies estimate a range of 14% to 100% for pain, 1% to 42%
for depression, and 4% to 91% for fatigue. The estimates’ lack of consistency
stems from both conceptualization and measurement problems, and weaknesses in
research methodology, the panel said.

Assessment

Most clinical assessments of pain, depression, and fatigue
rely on self-reporting by patients, who do the best job of assessing the
severity of their own symptoms, but the sickest patients often cannot complete
symptom questionnaires. Although a number of assessment tools exist, only a few
assess all three symptoms simultaneously.